=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821231747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN ANDREW KLEAN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2009
-----------------------------------------------------
Last Update Date | 06/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37868 US HIGHWAY 18
-----------------------------------------------------
City | PRAIRIE DU CHIEN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53821-8416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-357-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37868 US HIGHWAY 18
-----------------------------------------------------
City | PRAIRIE DU CHIEN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53821-8416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-357-2000
-----------------------------------------------------
Fax | 608-755-7892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 63317-21
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 63317-21
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------